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Symptomatic and asymptomatic intracerebral hemorrhages detected by magnetic resonance imaging after catheter ablation of atrial fibrillation

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Symptomatic intracerebral hemorrhages (ICHs) are a rare complication after atrial fibrillation (AF) catheter ablation, while the incidence of asymptomatic ICHs detected by magnetic resonance (MR) imaging remains unclear. This study aimed to investigate the incidence, characteristics, and predictors of new-onset ICHs on MR imaging after AF ablation.

Methods

We retrospectively studied 1257 consecutive AF ablation procedures in 1201 patients who underwent MR imaging on the day after the procedure. Repeat MR imaging within 3 months post-ablation was available in 352 procedures.

Results

Old ICHs on the initial MR imaging were observed in 28 procedures (2.2%). Post-ablation new ICHs were observed in 14 procedures (4.0%), including one symptomatic (0.3%) and 13 (3.7%) asymptomatic ICHs. One patient had a new ICH on the initial MR imaging, while the remaining 13 had such on the repeat MR imaging. A univariate analysis revealed that a previous ischemic stroke or transient ischemic attack (TIA) and the CHA2DS2-VASc score were positive predictors of new ICHs (odds ratios, 5.502 and 1.435; P = 0.004 and 0.044). The lesion diameter did not significantly differ between the old and new ICHs (median, 6.1 mm vs. 8.0 mm, P = 0.281), while the predominant location differed (lobar areas, 22.6% vs. 53.3%; cerebellum, 22.6% vs. 20.0%; others, 54.8% vs. 26.7%; P = 0.026).

Conclusions

A few asymptomatic ICHs may occur after AF ablation. Most of the post-ablation new ICHs occurred a few days or later after the procedure. A previous ischemic stroke/TIA and the CHA2DS2-VASc score may be risk factors for post-ablation ICHs.

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Acknowledgements

We would like to thank Mr. John Martin, Satoshi Tomioka, and Hirohiko Shinbo for their help in the preparation of the manuscript.

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Authors and Affiliations

  1. Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan

    Kohki Nakamura, Takehito Sasaki, Kentaro Minami, Yutaka Take, Koki Kimura, Yumiko Haraguchi, Wataru Sasaki, Shohei Kishi, Shingo Yoshimura, Yosuke Nakatani, Yuko Miki, Koji Goto, Kenichi Kaseno, Eiji Yamashita & Shigeto Naito

  2. Division of Radiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan

    Keiko Koyama

  3. Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8670, Japan

    Nobusada Funabashi

Authors
  1. Kohki Nakamura
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  2. Takehito Sasaki
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  3. Kentaro Minami
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  4. Yutaka Take
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  16. Nobusada Funabashi
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  17. Shigeto Naito
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Corresponding author

Correspondence to Kohki Nakamura.

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Nakamura, K., Sasaki, T., Minami, K. et al. Symptomatic and asymptomatic intracerebral hemorrhages detected by magnetic resonance imaging after catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 64, 443–454 (2022). https://doi.org/10.1007/s10840-021-01051-6

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  • DOI: https://doi.org/10.1007/s10840-021-01051-6

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